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Wellcare Simple Value (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellcare Simple Value (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Wellcare Simple Value (HMO-POS) in 2026, please refer to our full plan details page.
Wellcare Simple Value (HMO-POS) is a HMO-POS plan offered by Centene Corporation available for enrollment in 2025 to people living in Select Counties in IL. This plan received an overall rating of 3 out of 5 stars in 2026.
It's important to know that Wellcare Simple Value (HMO-POS) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Wellcare Simple Value (HMO-POS).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For Wellcare Simple Value (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $615.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $3900.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The Wellcare Simple Value (HMO-POS) prescription drug plan features an annual drug deductible of $615 and offers cost-effective options for generic medications. You will pay no copay for Tier 1 (Preferred Generic) and Tier 2 (Generic) drugs when filling prescriptions through a preferred pharmacy or preferred mail-order service. Additionally, Tier 6 (Select Care Drugs) are highly accessible with no copay at any standard or preferred pharmacy. For brand-name and specialty medications, cost-sharing is structured as a percentage of the drug cost. Tier 3 (Preferred Brand) and Tier 5 (Specialty Tier) drugs require a 25% coinsurance, while Tier 4 (Non-Preferred) drugs carry a 34% coinsurance across all pharmacy types. If you choose to use a standard pharmacy, Tier 1 and Tier 2 copays start as low as $5 and $10 respectively for a one-month supply.
Additional Benefits
The Wellcare Simple Value (HMO-POS) plan offers comprehensive medical coverage with predictable out-of-pocket costs, featuring no copay for primary care visits, preventive services, and urgent care. Inpatient hospital stays require a $275 daily copay for the first eight days with no copay thereafter, while emergency room visits carry a $150 copay that is waived upon hospital admission. Outpatient hospital services, ambulatory surgery, and ambulance rides are also covered under flat copayments with no coinsurance. This plan also includes valuable supplemental perks, offering no copay for routine dental care, annual routine eye exams, eyewear up to a $400 limit, and hearing aids up to $1,500 per ear. Additionally, members can access over-the-counter items, chronic illness meal benefits, and up to 12 one-way transportation trips to plan-approved locations at no cost. While some specialized services like medical equipment and dialysis require a 20% coinsurance, the plan minimizes overall costs for everyday healthcare needs.
Inpatient Hospital See details
Inpatient hospital services are covered by Wellcare Simple Value (HMO-POS) with no coinsurance, requiring a $275 daily copay for days 1 through 8 and no copay for days 9 through 90. This benefit is partially covered, as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered, although five additional acute care days are provided with no copay.
Outpatient Services See details
Wellcare Simple Value (HMO-POS) covers outpatient services with no coinsurance, including outpatient hospital services with a copay of $0 to $280 and observation services with a copay of $150 to $280 per stay. Ambulatory surgical center services require a $175 copay with no coinsurance, while outpatient substance abuse sessions have a $40 copay and blood services are covered with no copay or coinsurance.
Partial Hospitalization See details
Wellcare Simple Value (HMO-POS) covers partial hospitalization services with a $175.00 copay and no coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Wellcare Simple Value (HMO-POS) covers ground and air ambulance services with a $225 copay and no coinsurance, subject to prior authorization. Transportation services are partially covered with no copay or coinsurance for up to 12 one-way trips per year to plan-approved locations, though trips to any health-related location are not covered.
Emergency Services See details
Emergency services under Wellcare Simple Value (HMO-POS) are covered with a $150 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours, while urgently needed services have no copay and no coinsurance. Worldwide emergency and urgent services are partially covered up to a $50,000 maximum with a $150 copay and no coinsurance, but worldwide emergency transportation is not covered.
Primary Care See details
Primary care benefits under Wellcare Simple Value (HMO-POS) are partially covered, offering primary care visits with no copay and no coinsurance, and specialist and therapy visits for a $10 copay and no coinsurance. Telehealth services range from a $0 to $40 copay with 20% coinsurance, psychiatric and mental health services require a $40 copay and no coinsurance, while chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive services under the Wellcare Simple Value (HMO-POS) are largely covered with no copay and no coinsurance, including annual physical exams, fitness benefits, alternative therapies, and remote access technologies. While kidney disease education requires a 20% coinsurance with no copay, several supplemental services such as health education, weight management programs, and in-home safety assessments are not covered.
Hearing Services See details
Hearing services are partially covered by Wellcare Simple Value (HMO-POS), featuring a $10 copay and no coinsurance for Medicare-covered exams, alongside annual routine exams, fittings, and prescription hearing aids up to $1,500 per ear with no copays or coinsurance. OTC hearing aids, as well as inner ear, outer ear, and over the ear prescription hearing aids, are not covered.
Vision Services See details
Wellcare Simple Value (HMO-POS) offers partially covered vision services with no coinsurance and no deductibles, though prior authorization is required and other eye exam services are not covered. Routine eye exams (one per year) and eyewear—including contacts, eyeglasses, lenses, frames, and upgrades—are available with no copay, with eyewear covered up to a $400 annual limit.
Dental Services See details
Wellcare Simple Value (HMO-POS) offers partially covered dental services, featuring a $10 copay and no coinsurance for Medicare-covered dental, and no copay or coinsurance for preventive and most comprehensive services. Under this plan, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Wellcare Simple Value (HMO-POS) covers home infusion bundled services with no copay, although prior authorization is required. Medicare Part B insulin drugs are covered with a $35 copay and no coinsurance, while chemotherapy and other Part B drugs feature a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered under the Wellcare Simple Value (HMO-POS) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Wellcare Simple Value (HMO-POS) covers medical equipment, including durable medical equipment, prosthetics, and medical supplies, with no copay and a 20% coinsurance. Diabetic supplies are covered with no copay, while diabetic therapeutic shoes or inserts carry a 20% coinsurance, with prior authorization required for these benefits.
Diagnostic and Radiological Services See details
Wellcare Simple Value (HMO-POS) covers diagnostic and radiological services with prior authorization, featuring no coinsurance for diagnostic services, no copay for lab services, and a $0 to $50 copay for diagnostic tests. Radiological services require a 20% coinsurance for therapeutic radiology, a $50 copay for outpatient X-rays, and a copay starting at $0 for diagnostic radiology.
Home Health Services See details
Home Health Services are covered under the Wellcare Simple Value (HMO-POS) plan with no copay and a 20% coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Wellcare Simple Value (HMO-POS) plan, which provides no coverage for intensive cardiac, pulmonary, or supervised exercise therapy (SET) services.
Skilled Nursing Facility (SNF) See details
Skilled nursing facility (SNF) care is covered by Wellcare Simple Value (HMO-POS) with no coinsurance, requiring prior authorization but allowing admission without a prior three-day hospital stay. There is no copay for days 1 through 20 and days 41 through 100, while days 21 through 40 require a $218 daily copay, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by Wellcare Simple Value (HMO-POS), featuring over-the-counter (OTC) items and chronic illness meal benefits with no copay and no coinsurance. Acupuncture is not covered under this plan, and a referral is required to receive the meal benefit.
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